| NPI | 1679857544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557256) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: AZ 8302) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2015-09-14 |